Epithelioid hemangioendothelioma(EH)is a rare tumor arising from the vascular endothelial cells of soft tissue or visceral organs.The most common visceral site is the liver,where it is often involved in a multifocal m...Epithelioid hemangioendothelioma(EH)is a rare tumor arising from the vascular endothelial cells of soft tissue or visceral organs.The most common visceral site is the liver,where it is often involved in a multifocal man-ner known as hepatic EH(HEH).Surgical resection with curative intent represents the gold standard therapy.When surgery is not feasible,or in cases of metastatic disease,no standard medical treatment is currently indicated.In small series,drugs with anti-angiogenic activity(such as bevacizumab,sorafenib,thalidomide,and lenalidomide)have been proposed with promising results.We describe a 73-year-old man with multifocal non-resectable HEH treated with lenalidomide.Disease status was evaluated by abdominal ultrasound and magnetic resonance every four months.The patient was treated for a total of 39 mo with prolonged disease stabilization and,at the time of writing,is still under treatment with a good tolerance profile.During a short period of treatment discontinuation,the disease showed slight progression that immediately resolved after the reintroduction of lenalidomide.Lenalidomide may represent a valid treatment option for HEH due to its anti-angiogenic and antineoplastic activities.This preliminary result merits further study in a large series.展开更多
One only needs to study the soil and geologic history and location of the ancient Mississippi and Ohio Rivers to understand why Len Small levee if patched will continue to fail. Much of Dogtooth Bend located in Alexan...One only needs to study the soil and geologic history and location of the ancient Mississippi and Ohio Rivers to understand why Len Small levee if patched will continue to fail. Much of Dogtooth Bend located in Alexander County, Illinois was originally in the ancient Ohio River valley (Figure 1) alluvial sediments north and east of the confluence with the ancient Mississippi River. The ancient Ohio River valley soils underlain by alluvial sediments and have been easily eroded by the re-aligning modern Mississippi River which now travels through the bedrock controlled Thebes Gap (Figure 2) and into the Ancient Ohio river valley. The primary objectives of this paper are: 1) to explain why Len Small levee, Alexander County, Illinois, US will continue to breach during major flooding events if repaired and 2) to develop a new combined raised causeway and levee system which will provide a Mississippi River floodwater bypass, be sustainable, encourage and fund a land use change, restore the degraded highway road beds, protect remaining Dogtooth Bend farmsteads and farmland that have not yet been degraded by past flooding events and provide floodwater storage during major flooding events at the confluence of the Mississippi and Ohio Rivers.展开更多
The introduction of the antibiotics into clinical practice has significantly reduced the mortality of infectious diseases. Although chromosomally mediated β-1actamase is natural in many genera of bacteria, the intens...The introduction of the antibiotics into clinical practice has significantly reduced the mortality of infectious diseases. Although chromosomally mediated β-1actamase is natural in many genera of bacteria, the intensive use of antibiotics is the main cause for the increasing emergence of new β-1actamases. So far, more than 340 β-lactamases have been identified,1 among which, more than 200 are extended-spectrum β-lactamases （ESBLs）.2 The most prevalent β-lactamases are class A enzymes, including SHV and TEM. Genes encoding these enzymes generally located in large transferable plasmids. The dissemination of these plasmids attributes to the increasing incidence and spread of v-lactam resistance. It is important to investigate the prevalence and allelic distribution of genes encoding β-lactamase in the bacterial population in order to prevent the emergence of ESBLs in those bacteria and the spread of ESBLs in the clinical setting.展开更多
文摘Epithelioid hemangioendothelioma(EH)is a rare tumor arising from the vascular endothelial cells of soft tissue or visceral organs.The most common visceral site is the liver,where it is often involved in a multifocal man-ner known as hepatic EH(HEH).Surgical resection with curative intent represents the gold standard therapy.When surgery is not feasible,or in cases of metastatic disease,no standard medical treatment is currently indicated.In small series,drugs with anti-angiogenic activity(such as bevacizumab,sorafenib,thalidomide,and lenalidomide)have been proposed with promising results.We describe a 73-year-old man with multifocal non-resectable HEH treated with lenalidomide.Disease status was evaluated by abdominal ultrasound and magnetic resonance every four months.The patient was treated for a total of 39 mo with prolonged disease stabilization and,at the time of writing,is still under treatment with a good tolerance profile.During a short period of treatment discontinuation,the disease showed slight progression that immediately resolved after the reintroduction of lenalidomide.Lenalidomide may represent a valid treatment option for HEH due to its anti-angiogenic and antineoplastic activities.This preliminary result merits further study in a large series.
文摘One only needs to study the soil and geologic history and location of the ancient Mississippi and Ohio Rivers to understand why Len Small levee if patched will continue to fail. Much of Dogtooth Bend located in Alexander County, Illinois was originally in the ancient Ohio River valley (Figure 1) alluvial sediments north and east of the confluence with the ancient Mississippi River. The ancient Ohio River valley soils underlain by alluvial sediments and have been easily eroded by the re-aligning modern Mississippi River which now travels through the bedrock controlled Thebes Gap (Figure 2) and into the Ancient Ohio river valley. The primary objectives of this paper are: 1) to explain why Len Small levee, Alexander County, Illinois, US will continue to breach during major flooding events if repaired and 2) to develop a new combined raised causeway and levee system which will provide a Mississippi River floodwater bypass, be sustainable, encourage and fund a land use change, restore the degraded highway road beds, protect remaining Dogtooth Bend farmsteads and farmland that have not yet been degraded by past flooding events and provide floodwater storage during major flooding events at the confluence of the Mississippi and Ohio Rivers.
文摘The introduction of the antibiotics into clinical practice has significantly reduced the mortality of infectious diseases. Although chromosomally mediated β-1actamase is natural in many genera of bacteria, the intensive use of antibiotics is the main cause for the increasing emergence of new β-1actamases. So far, more than 340 β-lactamases have been identified,1 among which, more than 200 are extended-spectrum β-lactamases （ESBLs）.2 The most prevalent β-lactamases are class A enzymes, including SHV and TEM. Genes encoding these enzymes generally located in large transferable plasmids. The dissemination of these plasmids attributes to the increasing incidence and spread of v-lactam resistance. It is important to investigate the prevalence and allelic distribution of genes encoding β-lactamase in the bacterial population in order to prevent the emergence of ESBLs in those bacteria and the spread of ESBLs in the clinical setting.
